Ranolazine-induced lipid storage myopathy presenting with respiratory failure and head drop

Ranolazine is an anti-ischemic drug often used along with statins in patients with ischemic heart disease. Ranolazine-induced proximal myopathy or rhabdomyolysis have been rarely reported, but toxic effects of statins could not be completely ruled out in those cases. We report a 68-year-old man with ranolazine-induced myopathy who presented with respiratory insufficiency and head drop. Creatine kinase level was normal. The Patient continued to worsen despite statin cessation but markedly improved after stopping ranolazine. Muscle biopsy showed excessive lipid accumulation predominantly in type 1 myofibers. The precise mechanism of toxicity is not clear. Treating physicians should be aware of this rare but potentially debilitating adverse effect of ranolazine. Prognosis is good upon discontinuation of the offending drug.     

Extraction of phenolic components from an Aloe vera (Aloe barbadensis Miller) crop and their potential as antimicrobials and textile dyes

The present work focuses on the use of solid and agricultural residues from Aloe vera crops, as a source of antimicrobial agents and textile dyes. The roots from an A. vera plantation post-harvest were extracted with ethyl acetate, purified and phytochemically characterized to obtain five metabolites: aloesaponarin-I (1), deoxyerythrolaccin (2), lacaic acid D methyl ester (3), aloesaponarin-II (4), and aloesaponol-I (5). Acid hydrolysis of the solid industrial residue gave aloe-emodin (6) as the main product with a good yield. All of the components were tested for the first time against phytopathogenic bacteria strains, and deoxyerythrolaccin and lacaic acid D methyl ester were active against Xanthomonas campestris with MIC values of 46.86 and 93.75 μg/mL, respectively. Aloesaponarin-I and aloe-emodin, the main products, were tested as dyes for polyester fabrics using different mordants and pH bath conditions. The colour of each material was investigated in terms of the CIELAB L*, a* and b* values, and the colour fastness to light and washing was investigated according to the Mexican standard methods (NMX-A-074-INNTEX-2005; NMX-A-105-B02-INNTEX-2010). Aloesaponarin-I dyed polyester bright yellow but the final colour was very sensitive to the pH of the dye bath. Aloe-emodin dyed polyester deep yellow, and the fabrics showed good colour fastness to light and to domestic laundering. This study provides evidence that the phenolic components obtained from agricultural residues of the aloe industry can be useful organic alternatives as antimicrobial agents and textile dyes.     

Understanding feeding practices of Latinx mothers of infants and toddlers at risk for childhood obesity: A qualitative study

Infancy and toddlerhood are critical stages for the development of habits that can lead to future obesity, and caregivers have an important influence on these habits. We conducted this qualitative semistructured interview study to explore the feeding practices of Latinx mothers of young children who are at risk for childhood obesity in order to identify targets for obesity prevention. We interviewed Latinx mothers (N = 14) of a child ages 6–18 months with a weight‐for‐length ratio > 85th percentile at the time of recruitment. Two researchers independently read through the interviews, identified sections of the interviews pertaining to feeding, and used constant comparative methods to identify the following common themes: mothers overwhelmingly reported permissive feeding styles, driving overfeeding and frequent night‐time feeding. Mothers expressed some difficulty with transitioning to solid foods and reported desiring to feed their child healthy foods by minimizing juice and giving vegetables. Paediatricians and WIC staff were viewed by mothers as trustworthy sources of nutrition information. Most identified a connection between their child's weight and diet, but many lacked the insight or capacity to change their current practices. The mothers in our study provide insight into factors that may predispose young children to obesity and thus potential avenues to support these families. Healthcare providers can better serve them by giving clear, actionable advice on healthy feeding practices for their child, while understanding constraints that may make healthy habits difficult to implement. Paediatricians should be honest about their child's weight status early on to allow time for intervention.     

Pharmacological treatment for insomnia in patients with major depressive disorder

Introduction: Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice.

Areas covered: Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD.

Expert opinion: Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.     

Allergic and photoallergic contact dermatitis to chlorpromazine

Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.